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The Nurses by Alexandra Robbins

The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital - Alexandra Robbins

This is an interesting insider look at nursing. It doesn’t seem intellectually rigorous, so I’d take it with a grain of salt, but it is compelling reading. For a reader not in the medical profession, it did make me aware of many of the issues nurses face.

Slightly over half of the book consists of the narratives of four nurses whom the author followed for a year. Robbins is a strong storyteller and so these sections make for compelling reading, recounting the challenges the nurses face in their professional and personal lives. These women were generous in baring their lives for inspection, and their stories ring true even as they sometimes read like fiction, with a fast pace and lots of dialogue. One is recovering from an addiction to painkillers, which are all too easily obtained in the hospital; another is hurt by her exclusion from a clique at work; a third, as a brand-new nurse, struggles with her own social awkwardness as she learns the ropes. They all face work problems, including high patient loads and hospital policies that consistently disfavor nurses, along with personal problems such as infertility or unsupportive marriages. At the same time, they are all dedicated to their jobs and find moments of triumph and connection.

These stories are likely not representative of all nurses, however. All four protagonists work in hospital emergency rooms in the same unnamed city; all four are American-born white women under 45 (per the author, the average age of American nurses is 47); three are close friends with each other, and the fourth is a friendly acquaintance. I suspect the author has taken significant creative license, given the amount of dialogue and detail, and the fact that although she follows these women for a predetermined one-year period, all four stories wrap up with Hollywood endings.

And the author uncritically sides with these four nurses in all of their many conflicts at work. When one of them clashes with another nurse, the other nurse is described as lazy, bitchy, gossipy, cliquish, playing favorites, or putting profits before patients. When it’s with a doctor, the doctor is a bully or egotistical. One Dr. Baron (presumably not her real name) is actually referred to as “Dr. Bitch” by the author. In another case, a perky nurse whom the socially awkward Sam dislikes is labeled as annoying; when she volunteers to help others, she’s dismissed as seeking approval from colleagues rather than genuinely caring for patients, and when she’s upset by Sam’s brusque behavior, she’s condemned as a drama queen. As we eventually learn, nursing is a high-conflict profession and so the amount of discord these women experience may be typical; however, the author’s bending over backwards to justify her principals while blaming all their personality conflicts entirely on other people draws her credibility into question.

Interspersed with these four narratives are essays about various issues affecting nurses. These sections are informative: I had no idea, for instance, that nurses are regularly assaulted by patients and visitors (and sometimes even colleagues), to the point that American nurses have the third most dangerous profession, after police and corrections officers. And unlike those first two groups, nurses are provided with little protection, and physical assaults routinely go unreported and are not taken seriously by hospital administrators. Hospitals tend to focus on other numbers, such as patient satisfaction surveys (which by law can affect the funding they receive); but hospitals with higher patient satisfaction are often lower-performing in terms of medical outcomes, and vice versa.

But these essays are often wordy and sometimes muddled. For instance, the author writes about how the stereotype of nurse as sex kitten is harmful to the profession, then goes into bizarre detail about the sexual encounters that do occur: “Nurses have gotten intimate in on-call rooms, equipment lockers, storage closets, linen closets, family conference rooms, stairwells, visitor bathrooms, libraries, patient rooms, offices, and parking lots.” It is hard to see how this list of locations is helpful either to readers or to the author’s argument that nurses deserve more respect.

Some of the author’s tips for patients are helpful: avoid teaching hospitals in July, when new interns and residents start and death rates spike; know that anything wacky or ugly that you say is going in your chart; make sure doctors and nurses wash their hands on entering your room, and remind them if they don’t. Others seem less than useful: if I ever visited the ER with an embarrassing problem, I’d rather not know that nurses were laughing and placing bets behind my back. Some suggestions for families, such as handling basic care themselves, mostly seem like a nurse’s wish list.

In the end, I’m giving 3.5 stars for the narratives and 2.5 for the essays, for 3 stars overall. I appreciate this book’s giving me a window on a profession I knew little about, and found the nurse stories to be page-turners; but there are too many false notes for me to recommend it wholeheartedly.